Community Built Knowledge Base => Library: Content to critique for possible feature articles => Topic started by: Riv3rW0lf on February 08, 2022, 10:32:37 AM

Title: An interesting take on BPD as a "choice", and not a disease
Post by: Riv3rW0lf on February 08, 2022, 10:32:37 AM
Source : https://www.psychologytoday.com/ca/blog/matter-personality/201109/the-family-dynamics-patients-borderline-personality


In my last post, I discussed how children act out certain roles in their family of origin to try to stabilize parents who are emotionally unstable. Doing so also has the effect of maintaining dysfunctional relationship patterns so that the family operates in predictable ways (family homeostasis).

In today's post, I will look at the role that is played by the patient with borderline personality disorder (BPD), which I call the Spoiler. I will look at the dysfunctional family dynamics that I believe help to create the disorder.

For readers who are not familiar with the disorder, BPD is sort of the "jack of all trades" of personality dysfunction. People who have the diagnosis show gross disturbances in their ability to control their emotions, in their extremely chaotic interpersonal relationships, in their impulse control, and in their attempts to understand who or what they want to be in life (identity confusion).

These are the people who are not psychotic but who seem to show very poor judgment in interpersonal relationships, and who often seem to misinterpret in a negative way the most innocent-sounding comments made to them by others. They often cut, burn, or in other ways injure themselves. They make suicide threats and attempts and have anger control problems. They do not trust others easily, and they often "space out" or dissociate when under stress.

They engage in behavior referred to by therapists as splitting: Everyone else is treated either like a god or a complete pile of manure, with nothing in between. Interestingly, patients with BPD are often described by therapists as being superb manipulators. One must wonder how anyone who cannot simultaneously evaluate another person's strengths and weaknesses could possibly be a good manipulator. Simple answer: They could not. While the tendency of these individuals to "split" others into all good or all bad does derive from the bewildering contradictory behavior of the patient's parents or primary caretakers, usually it is just an act.

Their behavior is often so extreme that is natural to start to think that they must have some sort of brain disease. While genetics may predispose some individuals to be more prone to develop these characteristics than others, I am not among the psychiatrists who think BPD is a disease rather than dysfunctional personality traits that tend to co-occur in some children from some disturbed families.

Why do I say this? Mainly for two reasons. First, once I figured out how best to respond to patients with BPD in psychotherapy; and many of the therapists who see a lot of these patients independently stumbled upon the same techniques that I use. I noticed that patients with BPD could turn most of their symptoms off and on like a faucet, and at a moment's notice. [Clarification requested by many commenters: by "symptoms" I am speaking of behavioral symptoms, not how they feel inside]. Patients with what I believe to have significant brain disorders such as those with schizophrenia or melancholic depression are not able to do this. Second, when I finally get the real story of their lives, these patients nearly always seem to come from families that have severe family pathology.

According to a large number of studies, child abuse and/or neglect is the single most common biological, psychological, or social risk factors seen in individuals who develop the disorder. Of course, not every abused or neglected child develops BPD, and many patients who have the disorder were never sexually or physically abused.

On my Family Dysfunction and Mental Health blog, I discuss the movie Thirteen, which is almost an instruction manual on how to create patients with BPD without abusing them. It is not abuse per se, but the conflicting double messages given by the parents that are most likely to create borderline behavior in offspring.

The basic problem in the "borderline" family—to make a complicated and highly variable story tremendously oversimplified—is that the parents in such families see the role of being parents as the end all and be all of human existence. Yet, at the same time, deep down they hate being parents and/or see their children as an impediment to their personal fulfillment.

It's all well and good to try to understand the behavior of the individual with BPD in terms of a response to parental problems, but that just kicks the question of an explanation for the disorder back a generation. In many families, the parents' conflicting emotions are focused on one or more of their children, so that their other children may escape relatively unscathed.

The conflict over the role of "parent" leads to a pattern in which the parents go back and forth between hostile over-involvement with or without abuse, and hostile under-involvement with or without neglect.

The double message inherent in this pattern, in turn, leads the children to perceive a message from their parents that roughly translates into, "I need you, but I hate you." The over-involvement or under-involvement polarity may predominate in a particular family, but if one waits long enough, the other extreme rears its ugly head.

To stabilize the family homeostasis, the child who becomes the focus of the parents' ambivalence has to figure out the answer to the following question: How can he or she remain central in the parents' lives (even if contact seems limited) and still provide them with an easy justification and outlet for their anger so they do not have to feel guilty about it?

The role of the Spoiler is the perfect solution, and it is absolutely ingenious.

Spoiling behavior was first described by psychoanalyst Melanie Klein, who thought it had something to do with a child's primitive envy of the mother's breast. I just could not get my head around this almost psychotic-sounding explanation, but I had to admit that she was describing a very real pattern of adult behavior.

The spoiler child refuses to grow up, remains dependent in some way on the parent or a parent surrogate, and ruins and/or denigrates everything the parents try to do for them. A female child might start to lose or mistreat valuable designer clothes, and then demand both replacements of the expensive gifts and more of her mother's time.

Nothing the parent does or says is ever good enough. The "child," and this continues well into adulthood, will figuratively piss over everything the parent does for them. The parents' motives are consistently misinterpreted and they are constantly accused of being selfish, overly-demanding, stupid, or downright evil. They are treated with utter contempt.

This treatment of the parents is a form of invalidation.

Marsha Linehan, the developer of one of the most prominent psychotherapy treatment models for BPD, theorizes than an "invalidating environment" is, along with a genetic tendency to be over-emotional, one of the two major causes of BPD. She does not specify which environment she is talking about, but it is obviously the family in which the person grew up.

Invalidating someone else is not merely disagreeing with something that the other person says. It is a process in which individuals communicate to another that the opinions and emotions of the target are invalid, irrational, selfish, uncaring, stupid, most likely insane, and wrong, wrong, wrong. Invalidaters let it be known directly or indirectly that their target's views and feelings do not count for anything to anybody at any time or in any way. In some families, the invalidation becomes extreme, leading to physical abuse and even murder. However, invalidation can also be accomplished by verbal manipulations that invalidate in ways both subtle and confusing.

In families that produce a BPD offspring, invalidation of the child by the parents is omnipresent. After a while, the child starts doing to the parents exactly what the parents have been doing to the child. They start to give at least as good as they get.

Spoilers never become independent of their parents because they never really function as competent adults. This allows the parents to remain obsessed with the child, as seems to be their fervent desire. At the same time, the outrageous and scandalous behavior of the child gives the parents a much-needed excuse to vent their often unacknowledged hostility at their offspring.

The parents often still feel guilty over their poor performance in the parenting role, which again leads them to become unstable. In response, the child will start to try to "regulate" their emotions. If the parents get too angry, the child makes them feel guilty. If they start to feel too guilty, the child makes them angry.

The spoiler role is difficult to maintain, so the child needs to continually practice it with other people. The usual candidates for them to practice on are lovers, spouses, and of course therapists. No one else will continue to put up with them.

It is also important to realize that an adult who exhibits BPD behavior volunteers to perform the spoiler role, so their behavior cannot be blamed entirely on the parents. As I stated earlier, past a certain point, patients with BPD give as good as they get.